Advances Interview - Berger

Sleep Patterns
  "When you add fatigue into the model,you also get more pain, anxiety, depression, lower activity rates, poor appetite and sleep interruption."  


The second technique, stimulus control, instructs patients to use their bed only for sleep — no TV, reading or eating in bed. They also learn "not to make the bed your enemy." If subjects aren't asleep after 20 minutes in bed, they're instructed to get out of bed and try again later. It's important that the bed be associated with falling asleep quickly, Dr. Berger said.


The third technique is relaxation therapy — yoga, warm baths, candles, incense, soothing music or audio books. "The body sends out chemicals when it's time to naturally go to sleep," said Dr. Berger, "but modern society blocks those chemicals with all its technology. Before electricity, we were able to fall asleep more easily."

Finally, participants are taught to practice "good sleep hygiene," which includes avoidance of caffeine and heavy meals six hours before bedtime.

Women in both groups were given an actigraph to monitor 24-hour movement and activity. The size of a wristwatch and worn on the non-dominant wrist, the device scientifically measures sleep/wake, activity/rest and circadian body rhythms. "This is the largest data set on actigraphy in the world," Dr. Berger said.

Study participants meet with a research team member two days before each chemotherapy treatment for assessment and to reset the sleep plan for the next cycle. "It's a rigorous study," said Dr. Berger. "Each participant has a total of eight to 12 visits with a team member."

Dr. Berger has devoted the last 15 years to the discovery and description of factors that influence chemotherapy-related fatigue. She said prevailing thought in the past was to advise patients to reduce their activities, take time off work and get more sleep. Her research supports the contrary: that activity is beneficial. The social and interpersonal networks people build through daily activities prove therapeutic.

Through continued research, Dr. Berger hopes to refine sleep intervention techniques that dramatically enhance longterm quality of life for women who have chemotherapy for breast cancer.

"Of the 10 million cancer survivors today, five million are breast cancer survivors. One third of those women report a poor quality of life following treatment. That has to change."

Dr. Berger's research team includes Julie Chamberlain, MS, RN, Project Director; Lynne Farr, PhD, Physiologist; Trish Fischer, BSN, CCRC, Research Nurse; Brett Kuhn, PhD, Sleep Psychologist; Kathryn Lee, PhD, RN, FAAN, Consultant; Mary Pat Roh, BSN, Research Nurse; Susanna Von Essen, MD, Pulmonologist; Ann Kessinger, MD, Oncologist; Tom Davis, PharmD, Pharmacist; Sangeeta Agrawal, MSc, Research Analyst; and James Lynch, PhD, Statistician.

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advances spring 2007